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South Dakota rates for HCPCS 86053

Aquaporin-4 (neuromyelitis optica [NMO]) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.47 / $35.47 / $345.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.28 / $35.47 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.37 / $68.54 / $85.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.61 / $42.72 / $183.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.15 / $10.85 / $45.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $24.56 / $66.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $24.56 / $63.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $90.90 / $103.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.15 / $10.85 / $37.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $37.72 / $37.72